Camila Kümmel Duarte

Critical analysis of the American Diabetes Association dietary recommendations for cardiovascular disease in diabetes mellitus

Cardiovascular disease (CVD) is the main cause of mortality among patients with diabetes mellitus (DM), and dietary intervention is an essential measure to prevent and treat this complication. The aim of this manuscript was to review scientific evidence that underlies the dietetic recommendations of the American Diabetes Association (ADA) for prevention and treatment of CVD in patients with DM. The ADA guidelines are mostly based on studies performed on patients with CVD and without DM. The evidence-based dietary recommendations for patients with DM are to increase the intake of fish and soluble fibers. Although DM has been considered as an equivalent of established CVD, the adoption of the same dietary recommendations for patients without DM and with CVD for all patients with DM is still questionable -- especially considering the peculiarities of CVD in DM. Randomized clinical trials including patients with DM should provide further information regarding the benefits of these dietary interventions for CVD.

Low linolenic and linoleic acid consumption are associated with chronic kidney disease in patients with type 2 diabetes

Aim This cross-sectional study aimed to assess the association of the fat content in the diet with Diabetic Kidney Disease (DKD) in patients with type 2 diabetes. Methodology Patients from the Diabetes research clinic at Hospital de Clínicas de Porto Alegre (Brazil) were consecutively recruited. The inclusion criterion was the diagnosis of type 2 diabetes. The exclusion criteria were as follows: body mass index >40 kg/m2, heart failure, gastroparesis, diabetic diarrhea, dietary counseling by a registered dietitian during the previous 12 months, and inability to perform the weighed diet records (WDR). The dietary fatty acids (saturated, monounsaturated and polyunsaturated) consumption was estimated by 3-day WDR. Compliance with the WDR technique was assessed by comparison of protein intake estimated from the 3-day WDR and from the 24-h urinary nitrogen output performed on the third day of the WDR period. The presence of DKD was defined as urinary albumin excretion (UAE) ≥ 30 mg / 24 h or/and glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Urinary albumin was measured twice and eGFR was estimated by using the CKD-EPI equation. Results A total of 366 patients were evaluated; of these, 33% (n = 121) had DKD. Multivariate analysis showed that the intake of linolenic acid was negatively associated with DKD (OR = 0.57; 95% CI 0.35–0.93; P = 0.024), adjusted for gender, smoking, cardiovascular disease, ACE inhibitors and/or angiotensin receptor blocker use, systolic blood pressure, fasting plasma glucose and HDL cholesterol. In a separate model, similar results were observed for linoleic acid, adjusting to the same co-variables (OR = 0.95; 95% CI 0.91–0.99; P = 0.006). Conclusion The lower intake of polyunsaturated fatty acids, especially linolenic and linoleic acid, is associated with chronic kidney disease in patients with type 2 diabetes.

Physical activity level and hypoglycemia in type 1 diabetes patients

Introduction: The recommended management for individuals with type 1 diabetes (T1D) includes an intensive treatment with insulin therapy and the practice of regular exercise. However, this association is related with hypoglycemia episodes. Objective : The aim of this study was to perform a cross-sectional evaluation of the association between the physical activity (PA) level and hypoglycemia episodes reported in patients with T1D. Methods: Adult outpatients with T1D had their PA level assessed by the International Physical Activity Questionnaire (long form), considering the intensity of the physical activity (vigorous, moderate and/or walks) in daily activities, such as at work, means of transport, domestic activities and at leisure, and answered questions about self-care and hypoglycemia episodes. Results: The study included 126 patients who presented the following characteristics: mean age of 35 (28-47) years old and 16 (11- 24) years of diabetes duration, 55% women, HbA1c=9.3 ± 2.1%, and body mass index = 25.0 ± 4.2kg/m 2 . Very active patients had lower values of glucose and LDL-cholesterol when compared with the less active group. A greater proportion of active (48.1%) and very active patients (66.7%) reported practicing exercise regularly when compared with the less active subjects (13.3%; P=0.003). Less active patients had a three-fold chance of reporting hypoglycemia episodes when compared with very active patients (OR=3.49; CI 95%: 1.26-9.70; P=0.016). Conclusions: Less active adults with T1D presented more hypoglycemia, probably due to the practice of informal moderate and/or vigorous activities without specific self-care. Keywords: Exercise; self-care, blood glucose

Fatty acid composition in serum lipids and the renal function of type 2 diabetes mellitus patients

Materials and methods In this cross-sectional study, the patients were submitted to nutritional, clinical and laboratory evaluation, emphasizing the diabetic chronic complications. Serum fatty acids composition in total lipids was measured by gas chromatography. Albuminuria (24-hour urinary albumin excretion [UAE]) was measured twice and glomerular filtration rate (GFR) was estimated by using the CKDEPI equation.

Determinants of glycemic and blood pressure control in type 2 diabetes patients: 606 outpatients diabetes cohort.

Materials and methods 606 type 2 diabetes patients, outpatient Endocrine clinic, tertiary hospital, consecutively included between 20122014. Medical history, complete examination and laboratory evaluation performed (HbA1c, lipids, glomerular filtration rate -eGFRand urinary albumin excretion-UAE). Therapeutic targets defined according to American Diabetes Association: HbA1c <7% (<8% if comorbidities); blood pressure <140/90 mmHg, total cholesterol (TC) <200 mg/dL, HDL adjusted for gender and triglycerides (TG) <150 mg/dL. Approved by ethics committee (no 140073); statistical analysis PASW 20.0.

Association of dietary fat composition with kidney function decline in patients with type 2 diabetes

Background Chronic kidney disease is a major microvascular complication of Diabetes Mellitus (DM) and may affect about one third of the patients. Based on the evidence that a proportion of patients may have reduced glomerular filtration rate (GFR) without increased albuminuria, it is recommended to evaluate both parameters. Furthermore, both of them are considered prognostic factors of renal and cardiovascular mortality. Hence, the evaluation of the possible association between dietary fat content and renal dysfunction assessed by GFR is also relevant.